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ROP APPLICATION
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Busko,Jacob,Daniel
Name: __________________________________________
(Last)
(First)
4/9/16
____________________
(Middle)
Date
3337 el capitan ct
Present mailing address:___________________________________________________________
(P.O. Box or Street Number)
Merced, CA, 95348
_______________________________________________________________________________
(City)
(State)
( 209 ) 628-1142
(Telephone Number)
(Zip Code)
jdbusko24@[Link]
)____________________ ____________________________
(Alternative Telephone Number)
(Email Address)
Position applied for:_______________________________________________________________
Sports Camp Counselor
Skills and/or competencies which qualify you for this position:
Good with kids, i've played sports all my life and i'm good at teaching skills and coaching.
Languages spoken and/or written (other than English):___________________________________
none
Have you ever been convicted, pleaded guilty or no contest to a misdemeanor or felony?
No
Yes
If yes, explain:________________________________
Do you possess a valid California Drivers License?
No
Yes
_______________________
(Number)
RECORD OF EDUCATION
High School
Name of School
City/State
Merced High school
Merced, CA
Course of
study or
major
College/
University
Last year
completed
1 2 3 4
Did you
graduate?
Diploma
or degree
2016
diploma
1 2 3 4
Other
(Specify)
1 2 3 4
List appropriate extracurricular activities, clubs, organizations and courses for this position:
I do adult league basketball on sundays
AVAILABILITY
SUNDAY
3pm and up
MONDAY
3 pm and up
TUESDAY
3pm and up
WEDNESDAY
2pm and p
THURSDAY
2 pm nd up
FRIDAY
3pm and up
FULL TIME
PART TIME
SATURDAY
all day
RECORD OF EMPLOYMENT: (Begin with your most recent job)
Period of Employment
From:
Job Title and Duties Performed
Company Name, Address, and Phone Number
Sports Camp Counselor
Title__________________________Last
Salary: _____________
_________________________________________________
Duties
_________________________________________________
Teach kids sports and participate in activities with
the kids, feed them lunch, watch them at the pool,
keep things organized until parents pick them up,
clean up. Name:
Supervisors
Rob
_____________________________________________________
_________________________________________________
Title__________________________Last
Salary: _____________
Sports Camp Counselor
_________________________________________________
Duties:
_________________________________________________
Teach kids sports and participate in activities with
the kids, feed them lunch, watch them at the pool,
keep things organized until parents pick them up,
clean up.
_________________________________________________
To:
6/15
______
8/15
______
Mo / Yr
Mo/Yr
3
Total ____Yrs. ________Mo.
5
Hours Per Week:_________
Reason For Leaving:
only a summer job
From:
350 E Yosemite Ave, Merced, CA
To:
6/14
______
8/15
______
Mo/ Yr
Mo/Yr
3
Total ____Yrs. ________Mo.
Hours Per Week:_________
5
Reason For Leaving:
Only a summer job
Cliffs drysdale sports camp,
_________________________________________________
_________________________________________________
Cliffs Drysdale Sports Camp
350 E Yosemite Ave, Merced, CA
_________________________________________________
_________________________________________________
Supervisors Name:
Phil
________________________________________________
From:
To:
______
______
Mo /Yr
Mo/Yr
Title___________________________Last Salary: ____________
_________________________________________________
Duties:
_________________________________________________
Total ____Yrs. ________Mo.
_________________________________________________
Hours Per Week:_________
Reason For Leaving:
_________________________________________________
Supervisors Name:
________________________________________________
_________________________________________________
REFERENCES: Give the names of three persons not related to you.
Name
1.
Tommy Briggs
Complete Address (Include City, State, Zip)
205 West Olive Ave Merced, CA, 95340
Phone
209-349-2446
Occupation_______
Teacher/Coach
________________________________________________________________________________________________________________________________
2. Nick
Navarrette
3079 N. Parsons Ave. Merced, CA,95340
209-947-9944
Football Coach
________________________________________________________________________________________________________________________________
3.
Susan Odishoo
205 West Olive Ave Merced, CA, 95340
209-385-6437
High school Counselor
________________________________________________________________________________________________________________________________
I authorize investigation of all statements contained in this application.
I understand that misrepresentation or omission of facts is cause for dismissal.
Date:_________________________Signature:_________________________________________________________________
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Revised 7/10
